New approach: Up to 80% of people who have osteoarthritis can experience significant improvement in pain and mobility -- and reduce their need for medication and surgery -- when they combine dietary changes, supplement use and the right kind of exercise. This program provides significant relief within six weeks.

DIET RX

Inflammation in the body has been implicated in heart disease, diabetes and kidney disease -- and it also contributes to osteoarthritis.

The incidence of arthritis has steadily risen since the early 1900s, when processed foods, such as packaged crackers, cereals, bread and snack foods, began to dominate the American diet -- and more people started becoming obese. Most of these foods actually promote inflammation, which can cause joint and cartilage damage and aggravate arthritis pain.

Studies suggest that adding more foods with anti-inflammatory effects to the average American diet -- and reducing foods that promote inflammation -- can curb inflammation by 20% to 40%.

Best anti-inflammatory foods...

Apricots and berries contain large amounts of antioxidants, chemical compounds that reduce inflammation.

Almonds contain fiber, vitamin E and monounsaturated fats, all of which curb inflammation.

Other important steps...

Increase omega-3s. These inflammation-fighting essential fatty acids are mainly found in cold-water fish, such as salmon, tuna, mackerel and sardines. At least three three-ounce servings of fish per week provide adequate levels of omega-3s.

People who don't like fish, or don't eat it often, can take fish-oil supplements or flaxseed oil.

My advice: Take 2 g to 3 g daily of a fish-oil supplement that contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)... or one to three tablespoons daily of flaxseed oil.

Caution: Because fish oil taken at this dosage can have a blood-thinning effect, check with your doctor if you take a blood-thinning medication, such as warfarin (Coumadin).

Reduce omega-6s. Most Americans get far too many of these inflammation-promoting fatty acids in their diets. A century ago, the ratio of omega-6 to omega-3 fatty acids was about 2:1 for the typical American. Today, it's about 20:1. This imbalance boosts levels of a chemical by-product, arachidonic acid, that triggers inflammation.

My advice: Because omega-6s are found primarily in red meats, commercially processed foods (described earlier) and fast foods, anyone with arthritis should avoid these foods as much as possible.

Give up nightshades. Although the reason is unknown, tomatoes, white potatoes, eggplant and other foods in the nightshade family have been found to increase arthritis pain. It has been estimated that up to 20% of arthritis patients get worse when they eat these foods.

My advice: If you eat these foods and have arthritis pain, give them up completely for six months to see if there's an improvement. For a complete list of nightshade foods, go to the Arthritis Foundation Web site at www.arthritis.org and enter "nightshade" in the search box.

SUPPLEMENT RX

Americans spend billions of dollars annually on supplements to ease arthritis pain, but many of them are ineffective. Best choices...

Ginger. The biochemical structure of this herb (commonly used as a spice) is similar to that of NSAIDs, making it a powerful anti-inflammatory agent. A study of 250 patients at the University of Miami School of Medicine found that ginger, taken twice daily, was as effective as prescription and over-the-counter drugs at controlling arthritis pain.

My advice: Add several teaspoons of fresh ginger to vegetables, salads, etc., daily or take a daily supplement containing 500 mg of ginger.

Caution: Ginger thins the blood, so consult your doctor if you take blood-thinning medication.

Glucosamine and chondroitin. Taken in a combination supplement, such as Cosamine DS, these natural anti-inflammatories inhibit enzymes that break down cartilage and enhance the production of glycosaminoglycans, molecules that stimulate cartilage growth.

My advice: Take 1,500 mg of glucosamine and 1,200 mg of chondroitin daily. Or consider using a product called Zingerflex, which contains glucosamine and chondroitin as well as ginger.

Caution: If you have diabetes, consult your doctor before using glucosamine. It can raise blood sugar. Do not take glucosamine if you are allergic to shellfish.

EXERCISE RX

Osteoarthritis pain weakens muscles, which diminishes joint support. The result is more inflammation and pain, and faster progression of the underlying disease.

Common exercises, including running and traditional forms of yoga, actually can increase pain by putting too much pressure on the joints. Patients benefit most from medical exercise, which includes modified versions of common strengthening and stretching exercises, supervised by a physical therapist. (To locate a physical therapist in your area, contact the American Physical Therapy Association at 800-999-2782 or www.apta.org.)

It's best to perform medical exercises under the guidance of a physical therapist for one to two months before beginning an exercise program at home. Best choices...

Medical yoga improves joint strength and flexibility by strengthening muscles and moving joints through their full range of motion. Unlike conventional yoga, it does not require poses that put undue stress on the joints.

Pilates combines yoga-like stretching and breathing control to strengthen the "core" muscles in the lower back and abdomen, as well as muscles in the hips. Like medical yoga, it puts very little pressure on the joints. A move called One-Leg Circle is typical of the Pilates exercises that are recommended for arthritis patients.

To perform One-Leg Circle...

Lie on your back with your arms at your sides and your palms down. Tighten the abdominal muscles, press the lower back toward the floor and raise your right leg toward the ceiling. Point your toe.

Rotate your right leg clockwise. Breathe in during half the rotation, then exhale during the other half. Then rotate the leg in the other direction. Repeat the sequence four times. Repeat with your left leg.

Healthy breathing. Most of us take shallow breaths from the upper lungs -- a breathing pattern that increases levels of stress hormones and heightens pain.

Better: Deep breathing, which promotes the release of pain-relieving chemicals called endorphins. Patients who breathe deeply for five minutes daily have less pain for several hours afterward. Practice deep breathing in addition to a regular exercise program.

Here's how...

Sit in a chair with both feet flat on the floor. Close your mouth, place one hand on your stomach and breathe deeply through your nose until you can feel your stomach expanding. Hold your breath for 10 seconds.

Exhale through your nose, contracting your stomach until you've expelled as much air as possible. Hold the "emptiness" for a moment before inhaling again.

Repeat the cycle for at least five consecutive minutes daily.

Bottom Line/Health interviewed Vijay Vad, MD, a sports medicine physician and researcher specializing in minimally invasive arthritis therapies at the Hospital for Special Surgery in New York City. He is an assistant professor of rehabilitation medicine at Weill Medical College of Cornell University, also in New York City, and the author of Arthritis Rx (Gotham).